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Using nicotine gum and varenicline (Chantix)

Dear Alice,

Can I chew Nicorette gum instead of smoking when starting Champix tablets?

Dear Reader,

You are smart to question how different medications interact when used concurrently. Champix, called Chantix in the United States and globally by its generic name varenicline, is a prescription medication that can help individuals quit smoking by partially stimulating nicotine receptors in cells throughout the body. Nicorette gum, a type of nicotine replacement therapy (NRT), is also a tool to help smokers quit by providing individuals with the nicotine they crave by delivering the substance in controlled amounts through the lining of the mouth. NRT is available in many other forms including lozenges, patches, inhalers, and nasal sprays. The short answer is that there is disagreement among researchers about whether or not there are negative consequences to chewing nicotine gum while taking varenicline. While some studies suggest no harmful side effects to using them together, others have found that adverse effects from using both at the same time. So, what does the current evidence say?

Pfizer, the producers of Chantix, advises against taking it in combination with any other NRT — which would include nicotine gum — due to possible side effects.

The National Institutes of Health (NIH) advises individuals wanting to use both at once to talk to their health care providers because the appropriate dosage of varenicline may need to be altered due to the combination.

Research studies ultimately concluded that further research is necessary to determine the safety of using varenicline and NRTs together. One study found taking the two together was possibly more effective than taking either alone, producing only mild side effects (such as skin reactions from the nicotine patch). Another study similarly found that the two taken together could potentially be beneficial. However, this study examined patients in a residential treatment program, so the results may not be generalizable. These studies did not specifically examine the combination of nicotine gum and varenicline — one used a variety of NRTs and the other used only the nicotine patch as the NRT.

Because research regarding the effectiveness and safety of chewing nicotine gum while taking varenicline is not conclusive, it’s probably a good idea to talk to your health care provider about whether using the two simultaneously is best for you. Another option you might discuss is the combination of NRT with bupropion (brand name: Zyban or Wellbutrin), which has been recommended by some professionals for heavy smokers. Hats off to you for checking it out before you chew!